THEIR RULES, OUR PAIN
Real stories of people trampled by the insurance companies
Parvin Mottaghi completed the Blue Shield application on Sept. 14, 2005. In her application she disclosed that she had respiratory problems, specifically bronchitis.Blue Shield approved coverage on Oct. 1, 2004. On Feb. 24, 2005, Parvin went to the Center for Interventional Cardiology and Nephrology for a nuclear cardiology study. Blue Shield approved the exam.
After numerous tests, Parvin's doctors determined that she needed open heart surgery for a defective heart valve. Blue Shield authorized the surgery, which was performed on Sept. 1, 2005.
Blue Shield cancelled (rescinded) her coverage on March 21, 2006, leaving Parvin with about $100,000 in medical bills.
This insurance nightmare was outlined in a lawsuit against the insurer:
"WellPoint—the nation's largest health insurer—its subsidiary Blue Cross of California, and Blue Shield, were named in 13 new lawsuits today for canceling health insurance policies and refusing to pay medical bills after patients sought treatment. ...The lawsuits bring to light a grave threat to patients by companies trying to avoid paying legitimate claims, according to the Foundation for Taxpayer and Consumer Rights (FTCR). WellPoint announced on Wednesday that its 2006 first-quarter profit increased by 20 percent in part because the company paid less in medical claims."
—"Insurance Cancellation Scandal Widens: WellPoint, Blue Cross & Blue Shield Sued For Illegal Denials of Health Coverage," U.S. Newswire, April 27, 2006
But getting justice is no easy matter. Take the case of Steve Hailey. He's a small-business owner whose coverage was canceled by Blue Shield of California after he had a disabling car accident. He filed a lawsuit against Blue Shield, but while his case winds it way through the court system - which can take years and years - his health continues to deteriorate. He can't afford physical rehabilitation and other needed medical care. Prevented from getting a needed operation in time, Mr. Hailey now permanently depends on a catheter.
Canceling people's policy when they get sick is a common industry practice. Learn more about the insurance industry's Foul Play.
Read other stories in the "Their Rules, Our Pain" archive.
LATEST SCORECARD
Fifty-eight percent of primary care doctors in the U.S. report their patients often have difficulty paying for medications and care, and half of U.S. doctors spend substantial time dealing with restrictions insurance companies place on their patients’ care, according to the 2009 Commonwealth Fund International Health Policy Survey.
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Families saw their premiums for job-based health insurance rise to an average of $13,375 annually in 2009, with workers paying an average share of $3,515 and employers paying $9,860.
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